Atypical fungal vertebral osteomyelitis in a tsunami survivor of the Great East Japan Earthquake.

Abstract

Case report. We report a rare case of fungal vertebral osteomyelitis in a tsunami survivor of the Great East Japan Earthquake. Fungal vertebral osteomyelitis due to Scedosporium apiospermum (S. apiospermum) is extremely rare. We describe the case of a 45-year-old male who developed vertebral osteomyelitis by S. apiospermum 1 month after near drowning in the huge tsunami after the Great East Japan Earthquake. The patient was treated with a combination of percutaneous posterolateral endoscopic debridement and antifungal therapy. The case was evaluated with radiography and computed tomography, and his white blood cell count and C-reactive protein level in serum were measured 20 months after initiation of treatment. The patient had no low back pain and both white blood cell count and C-reactive protein had remained normal. Radiographs and computed tomography of lumbar spine demonstrated sclerotic change of endplates and spur formation bridging the L3 and L4 vertebral bodies. We report a rare case of the fungal vertebral osteomyelitis caused by S. apiospermum. If a patient develops severe back pain after a near-drowning episode in dirty water such as a swamp or a river, the clinician should be suspicious of the possibility of fungal spondylitis by S. apiospermum.